Author Archives: Chris Garrington

Health and place: How levelling up health can keep older workers working

As part of its levelling up agenda, the UK Government has set itself an ambitious target to add five additional healthy years to the average UK lifespan by 2035. In this blog Dr Emily Murray from the Department of Epidemiology and Public Health at University College London highlights lessons from the Health in Older People in Places project (HOPE), which she leads. HOPE uses data from the ONS Longitudinal Study to showing the link between levels of employment and health in a place.

We know place matters when working to extend healthy life expectancy (HLE) – there are large inequalities in older people’s health, depending on where they live. The Government recognises this and has set target of narrowing the gap between those living in the ‘healthiest’ and ‘unhealthiest’ local authority areas by 2030.

There are strong links, too, between the health of the population in a local area and levels of employment. So if we want people to be able to stay healthy and to work for longer, narrowing these gaps can make a real difference.

Staying in work

If the UK had achieved the current levelling up agenda goal of reducing the HLE gap by five years between 2001 and 2011, older people’s participation in the labour market would have increased by 3.7 per cent between 2001 and 2011. That would have meant 250,000 additional older people in paid employment. The HOPE project used Disability-Free Life Expectancy (DFLE) g as a proxy for HLE, as HLE data for local authorities was not available in 2001.

While disability-free life expectancy (DFLE) improved overall in the UK from 1991 to 2011, there was still a significant gap between the local authority areas considered the ‘healthiest’ and the ‘unhealthiest’. In 2011, DFLE at age 50 varied from 13.8 to 25.0 years – that’s a gap of 11.3 years between the healthiest and unhealthiest areas, which widened during the study period.

Unfortunately, over a decade later, the conversation hasn’t moved on much further. Health Equity in England: The Marmot Review 10 Years On, the 2020 follow-up to Sir Michael Marmot’s landmark study, found that the health gap between wealthy and deprived areas had continued to grow.

The HOPE project has built on this research by using Census data for England and Wales to show the link between levels of employment and health in a place.

It finds:

  • The higher the proportion of older people with poor health in a place, the less likely it is that any adults in that place will be in paid work. For example:
      • Older workers from the unhealthiest areas were 60 per cent more likely to be out of work than those who live in the ‘healthiest’ areas
      • Women aged 50-74 living in the ‘healthiest’ areas re 5.6 per cent more likely to be in paid work than those living in the ‘unhealthiest’ areas.
      • Men aged 50-74 living in the ‘healthiest’ areas were 7.1 per cent more likely to be in paid work than those living in the ‘unhealthiest’.

  • How we measure health in a place matters: links between health in a place and employment are stronger for self-rated health measures, compared with life expectancy figures or mortality indicators.
  • Historically disadvantaged areas continue to struggle: areas where people left paid work at a younger age due to poor health in 1991 were much more likely to experience this trend in 2011 as well.
  • This disproportionately affects people in manual occupations: they’re much more likely to experience ill health, and they can expect four fewer years of healthy life beyond age 50, compared with workers in administrative or professional roles.
  • There’s a correlation between health in a place and younger people being in paid employment: for example, the probability of a woman aged 16 to 49 not being in paid work was 33.7 per cent in the ‘unhealthiest’ areas compared with 26.3 per cent in the ‘healthiest’ areas.
  • Those working in professional occupations were more likely to be in work 10 years later than those working in elementary occupations or doing repetitive manual labour: this gap in employment outcomes was most marked for people living in ‘unhealthy’ areas.

The fallout from the COVID-19 pandemic and the current cost of living crisis are likely to widen existing inequalities. So it’s unclear how the Government intends to achieve its ambitious goals to increase healthy life expectancy and to narrow the gap between those in the ‘healthiest’ and ‘unhealthiest’ areas, especially given its recent decision to abandon the promised white paper on health disparities. 

We recommend that The Government should: 

• Increase spending on preventative health programmes to at least 6 per cent of the national health budget. This is in line with Canada, who currently invest the most in prevention across the G20 and continue to raise this proportion in accordance with the rise in preventable diseases. 

• Earmark part of the £4.8 billion levelling up infrastructure fund for projects that will create jobs suitable for older workers in the ‘unhealthiest’ local authority areas, especially in those where a high proportion of employment is in manual work. 

• Collect, monitor and publish data every year on health in a place, in particular self-rated health measures and labour market participation for people over the age of 50. 

• Confirm that there will be another census in 2031 and add detailed questions about health and labour market participation for people aged over 50. 

• Improve access to medical services to allow older people in poor health to remain in work. This includes reducing wait times to see a GP and for referrals, treatments and A&E. 

• Provide support, including career training and advice, to help older workers transition to less physically demanding roles, especially those in manual roles. 

Local authorities should: 

• Develop a five-year strategy to increase employment rates for people aged over 50 in the ‘unhealthiest’ communities, in partnership with business. This strategy should recognise that older women often face additional barriers to employment apart from health barriers. 

• Include local targets to improve population health in line with the national average for people aged 50 to 74 as part of their annual planning exercise. 

• Increase support for older workers in manual occupations to stay in employment. For example, training and financial support, either through the benefits system or apprenticeship schemes, can help older workers transition to less physically demanding jobs as they age. 

• Strengthen local tailoring of prevention programmes to ensure that services fully cater to local population health requirements. 

• Address ageism at a local level, by educating and informing people on how to receive the best care to prevent or manage health conditions, regardless of age. The aim is to challenge the perception that long-term conditions are an inevitable consequence of old age when many are preventable. Local authorities should also work with businesses to challenge employer perceptions that older people’s health is a barrier to their participation in the labour market.

Although the prevalent narrative is often that individual health is an individual problem rather than a societal one, the whole community is affected by poor health. It’s not just about helping people live longer, healthier lives but supporting local economies and economic growth.

The levelling up agenda is more important now than ever, and it’s vital it is not sidelined. 

The Health of Older People in Places (HOPE) project is a multidisciplinary research project funded by the Health Foundation under the Social and Economic Value of Health in a Place (SEVHP) programme. The research team includes scientists from the Department of Epidemiology and Public Health at University College London (UCL) and the School of Geography at the University of Leeds. The full report, Health and place: How levelling up health can keep older workers working, is available here. The report was written and published by the International Longevity Centre, UK.

The work was launched on October 19, 2022, at an event whose keynote speakers included Lord James Bethell, Parliamentary Under Secretary of State at the Department of Health and Social Care. Slides from the event are available here: https://ilcuk.org.uk/hope-project-report/

Dr Murray discuss the work further along with Dr Brian Beach in this Linking our Lives podcast.

Unsocial working hours: are these compatible for parents and families?

A recently-launched Parliamentary inquiry is asking if policy needs to be changed to deal with the personal impact of night time or shift work. So how do unsocial working hours affect parents? Afshin Zilanawala from the University of Southampton and Anne McMunn from the ESRC International Centre for Lifecourse Studies at University College London discuss research which finds shift work, that is working non standard schedules (nights, evenings, weekends), can impact negatively on fathers’ mental health – though it also enables them to spend more time parenting.

Five years ago, the Taylor Review of Working Practices named work-life balance as one of the key foundations of quality work. It also highlighted the benefits of flexible working and said this enabled people to agree working patterns to fit in with family life and other caring commitments.

Now the Parliamentary  Business, Energy and Industrial Strategy Committee has launched an inquiry into the UK’s labour market – and five years on from the review, it will ask what the Government should be doing to address issues raised in its report: “Are there particular types of work, for example night-time or shift work, which warrant further consideration in respect of the impact of that work on workers?” 

We think the research we’ve undertaken as part of a wide-ranging project looking at the health implications of shift work for parents and children can help answer this. So why should we care about unsocial working hours?

In the last half century, global economies have faced remarkable transformations to their labor markets, such as demand for services during non daytime hours and an increase in the service sector. These changes mean more parents are working a nonstandard schedule (i.e., outside 8 a.m.-6 p.m. hours) and such work schedules could have important implications for parents and their children and their family life. 

Using data from the Millennium Cohort Study (MCS), which is following nearly 19,000 children born in the UK in the early 2000s, we looked at the issue from two angles: first, how do unsocial hours affect parents’ mental health and their relationships with their partners/spouses? And second, do fathers parent their children differently if they work evenings, nights or weekends? 

First, we wanted to get a better handle on whether parents’ mental health and relationship happiness are somehow linked with their experiences of unsocial working hours. Our aim here was to bring fresh understanding to the role of the 24/7 economy in the lives of working families.

We were able to access data gathered over a number of years from MCS participants on the relationship happiness of around 11,500 mothers and fathers. There was also information on the mental health of 12,600 mothers and 11,600 fathers.

Self-assessed wellbeing

Mothers and fathers were asked to self-assess their wellbeing using a set of nine questions covering emotional disturbance and associated physical symptoms. Couples reported on their relationship happiness using a score from 0 – very unhappy – to 6 – very happy.

Parents who reported being in paid work were asked if they regularly worked evenings, nights and/or weekends—collectively termed ‘nonstandard work schedules.’ Four out of 10 working mothers reported working non-standard hours, along with 57 per cent of working fathers.

We could see that fathers who did this type of work tended to have higher family income than women who did so. Thirty-five per cent of fathers worked more than 45 hours per week, compared with just four per cent of mothers

There was no significant effect on the mental health of mothers who worked unsocial hours although they had lower relationship happiness scores if they worked standard hours and their partners worked non-standard ones.

We did find fathers who moved into evening or weekend work had worse mental health, though fathers’ non-standard work schedules were not significantly associated with relationship happiness.

Integrating work and family demands

Thus, one of our key findings is the absence of any overwhelmingly negative association between non-standard work schedules and mothers’ mental health. Maybe working non-standard work schedules enables families to organise their lives in a way that integrates work with family demands, as the Taylor Review suggested. So, mothers may be using such work schedules as a deliberate strategy to balance work and family needs – while other studies have suggested otherwise, they focused on the first two years of life while we were able to look across the first decade of a child’s life.

Our second key finding is that non-standard work is associated with worse mental health for fathers. This was particularly the case for those who worked evenings and weekends. 

Why might results differ between mothers and fathers? Some research has suggested fathers are increasingly seen both as caregivers and as income providers. For fathers working non-standard hours this may be even more the case, perhaps placing them under new forms of strain. 

The role of fathers

Our second study (see below) looked in more detail at the dual roles of fathers: how do their work schedules and those of their partners interact with parenting in infancy and middle childhood? We were able to look at the time spent on basic care when children were nine months old and when they were seven years, and we were also able to look at time spent on physical play or recreation with seven-year-olds.

Fathers of nine-month-old babies were asked how often they looked after them alone, changed nappies, administered feeds or got up in the night. Fathers of seven-year-olds were asked if they helped their child get ready for bed or looked after them alone. They were also asked how often they read with or to their child, told stories, did musical activities, drew, played physically active games, took the child to the park or playground or played with toys or games indoors.

Fathers tended to do more care with seven-year-olds than they did with younger children. Those who worked evenings did less basic care than those working standard hours in infancy and in middle childhood.

Those who worked nights did more basic care both when children were infants and aged seven, while working weekends was linked to lower levels both of basic care and of play.

Policy implications

Our findings have potential implications both for policy and for practice in workplaces: pay premiums for working outside of standard hours, incentives for child-care facilities to remain open in the evenings and weekends, and predictable work schedules which enable families to maintain routines could all help.

In supportive workplaces fathers are able to make more use of paternity and parental leave. And the pandemic has shown us how many jobs can be worked flexibly. To ensure flexible working is inclusive, employers can advertise vacancies as flexible and reduce the qualifying period – currently 26 weeks in new employment – before requesting flexible work schedules. They might also wish to work to reduce stigma around flexible working for men, and to ensure policies are geared as much towards fathers as mothers. Lastly, interventions could help parents manage the stresses and challenges of non-standard working.

Our results call for further understanding of the mechanisms that enable or constrain parenting activities when parents work non-standard hours and how this varies between countries.

Making It Work: Fathers’ Nonstandard Work Schedules and Parenting Activities is research by Afshin Zilanawala and Anne McMunn and is published in the Journal of Marriage and Family 

Nonstandard work schedules in the UK: What are the implications for parental mental health and relationship happiness? is research by Afshin Zilanawala and Anne McMunn and is published in Community, Work and Family.

Let’s be fair! The importance of a balanced approach as we extend working lives

Extending people’s working lives has become a well-established policy in many parts of Europe as governments seek to reduce state pension costs in the context of growing ageing populations. But there are concerns about the health of older workers and what poor health among workers might mean for sickness absence rates and social security costs. New research looking at working longer and sickness absence rates suggests that it might be possible to raise the retirement age without increasing sickness absence rates and social security costs unduly, but the researchers also raise concerns about widening health and social inequalities. Authors of the research Kristin Farrants and Kristina Alexanderson from Karolinska Institutet in Sweden and Jenny Head at University College London outline their findings.

It is generally thought that more people remaining in paid work will put less strain on public pension systems, since there will be more people paying into the system, and fewer people drawing on it, even if some people withdraw their old age pension at the same time as they have paid work.

The flip side of this thinking is that there could be a large group of people, especially those on low incomes and with lower levels of education, who may simply not be healthy enough to justify those increases in retirement age. In other words, increasing the pension age could lead to higher costs for the sickness absence insurance system.

In our research, the first to look at the links between being in paid work and sickness absence after the age of 65, we used Swedish data to look at a 12-year period of the lives of 218,000 workers who turned 65 in 2000, 2005, or 2010.

In line with policies to encourage people to work longer, we could see that the proportion of each of our cohorts in paid work after 65 did indeed increase over time. In fact, between the 2000 and 2010 cohorts, the number of people in paid work aged above 65 doubled from around 50 to 100 thousand. However, in the studied years there were no changes introduced regarding change of pension years. Age 65 was the prevalent age for old-age pension, which could be taken at 61.

Sickness absence

When we looked at sickness absence, the proportion of workers aged 66 – 71 years with a sickness absence spell lasting for more than 14 days increased only marginally between the 2000 and 2010 cohorts. This indicates that there is a health potential, a justification for further increases in state pension ages and reassurance for those worried about the social and economic knock-ons of extending working lives.

However, closer scrutiny of the data threw up some concerns around who was most likely to work after age 65 and the implications of that – in other words would some people from certain backgrounds benefit more than others from the ability to work longer and remain healthy thus reinforcing inequalities?

Being a man, having high education, being born in Sweden, living in a large city, and having no prior sickness absence or (especially) part-time disability pension was associated with being in paid work after age 65.

Among those in paid work after age 65, being born in the “Nordic countries outside Sweden” for women, and in “EU-27 outside the Nordic countries” or in “the rest of the world” for men, and living in a large city, having prior sickness absence, and no prior disability pension was associated with having sickness absence.

Actually, several of those with previous sickness absence and/or part-time disability pension also continued in paid work. Those, as well as others, of course had complaints that sometimes led to work incapacity and need of sickness absence – however, to a much lower degree than when aged 60-64.

Possible reasons for their lower sickness absence, especially in relation to the massive increase in proportions of people in paid work, warrants further investigations. The general better health of older people might be one of those aspects, however, work adjustments regarding work hours, work times, work tasks might be others.

Policy makers need to consider how they can best support people with different health conditions to remain in paid work after the age of 65 if health and income inequalities are not to become entrenched and wider as state pension ages rise further in the future. Fairness and balance are key!

Trends in Associations Between Sickness Absence Before the Age of 65 and Being in Paid Work After the Age of 65: Prospective Study of Three Total Population Cohorts is research by Kristin Farrants, Jenny Head and Kristina Alexanderson and is published in the Journal of Aging and Social Policy.

Were women’s domestic burdens eased by Covid-19 lockdowns? And will the pandemic have a lasting effect on household work-sharing?

In October 2020, WorkLife featured research  from Baowen Xue and Anne McMunn showing how badly the pandemic was affecting the mental health of working parents, especially single mothers. The researchers expressed concerns over the reversal of pre-pandemic trends towards a more gender equal society and supported calls from the Women’s Budget Group for a care-led recovery. Now a team of researchers from the University of Bristol-led Equal Lives project has gone on to look at the way domestic work was shared during and after lockdown in 2020. Susan Harkness from the University of Bristol and Aleja Rodriguez Sanchez from Humboldt University in Berlin explain what they found and the implications for this hard-hit group.

Covid-19 has confined whole families to their homes and has changed the way domestic work is shared, but those with young children have seen a quicker return to the way things were pre-lockdown, something that indicates a ‘re-traditionalisation’ of roles for this particular group of hard-hit women.

The first Covid-19 lockdowns in the Spring of 2020 threw parents and children into unfamiliar situations, with whole families working or studying from home. So, for opposite-sex couples, what did this mean for traditional gender divisions of household chores? Were women’s greater domestic burdens altered by having both parents at home? And what happened as the lockdown started to ease in the Summer of 2020?

The Equal Lives team set out to answer these questions using data gathered by the Understanding Society COVID-19 study in April, May, June and September 2020. Understanding Society is the largest longitudinal household panel study of its kind, and follows a sample of UK households: from April 2020 its participants were asked to complete monthly web surveys about the impact of the pandemic on their lives.

Responses from people of working age who were in opposite-gender relationships which continued throughout the study period – provided a final sample size of just over 2000 couples.

Lockdown shocks

These couples were asked about the gender division of housework during the first lock-down, during April 2020. This was compared with information collected from pre-lockdown surveys, carried out during 2019. They were also asked whether those changes persisted when the first lockdown eased. We compared those with no children at home to those with children of various ages.

What we saw was that, as with other types of shock which affect the division of labour, couples tended to adapt. Initially, there was a moderate amount of gender rebalancing in the sharing of domestic work, but this was dependent on the number and age of the couple’s children. However, by September 2020 the old gender divisions had largely been re-established. 

Overall the findings showed that both men’s and women’s paid working hours reduced substantially in the Spring of 2020 but recovered by September. During the Spring lockdown, around a third of both male and female respondents were employed but working from home; a figure which reduced to just under a quarter by September. Around one in five women and one in seven men were furloughed in the Spring, but this dropped to fewer than one in 20 by September.

Overall, women’s share of housework fell from 65 per cent pre-Covid to 60 per cent during the first lockdown. By September this rose back to 62 per cent. Both men and women increased their hours of domestic work during lockdown – from 13 to just under 15 for women, and from six and a half to nine and a half for men. 

Childcare burdens

When the respondents were split into three groups – those who had no children living at home, those who had children under the age of five and those who had older children – marked differences emerged. 

For couples without children at home, women’s share of domestic labour fell during the Spring and continued to fall after the Summer. Though these women still did more domestic work than their partners, their input did not return to pre-Covid levels.

For those with children aged 6-15, the drop in women’s share of housework was partially reversed by September, but the bounce back was less marked and they were still doing less than before the pandemic. 

But for those with children under five, the drop in women’s share of housework was reversed completely by September despite being more marked than that of other groups in Spring.

Family dynamics 

So what do we make of this? In terms of family dynamics, the lockdown may have had more lasting effects for some families than for others. Fears that advances in gender equality could be reversed during the pandemic were more real for those with very young children, who were much less able to keep themselves busy and who were not offered online education.  

One important reason for the division of labour during lockdown was men’s and women’s working hours – women with young children tended to reduce their paid working hours more in order to take on the increased burden of care. 

Our study highlights the need for a nuanced perspective on changes to family life during the pandemic and further research is needed to look at whether extended family networks were able to alleviate the increased care burden for some families, and at how the pandemic affected the mental health of women with and without children. Additionally, it would be useful to look at how different countries’ lockdowns might have affected families differently. 

Gendered division of housework during the COVID-19 pandemic: temporary shocks or dura-ble change? is research by Alejandra Rodríguez Sánchez, Anette E. Fasang and Susan E. Harkness and is published by Demographic Research.

Who suffers most from the health effects of long-term work stress?

As populations across the developed world grow older, Governments are keen to find ways to enable workers to stay active and fit for longer. We know work-related stress can lead to long-term health problems: but which types of employment histories are particularly harmful, and how do the effects play out over time? A new study by Morten Wahrendorf, Tarani Chandola and colleagues points to a need for early intervention with disadvantaged groups of workers.

Most studies on occupational stress focus on a particular point in time. But what if the effects of troubled working lives build up over many years, in terms of adverse employment trajectories over an extended time period? Some workers suffer repeated periods of unemployment throughout their working lives, for instance. We wanted to know how different types of work histories might be linked to health problems in later life.

We were able to examine these questions using data from the French CONSTANCES cohort study, which allowed us to combine information on participants’ employment histories from age 25-45 with health-related information.

Can stressful working lives lead to health issues over a long period? To address this question, we looked at a sub-sample of just over 90,000 people of the CONSTANCES study who had been in work between the ages of 25 and 45, and who had not had to leave work or take a break due to ill health during that period.

The information we had included the numbers of temporary jobs participants held and the number of job changes they had; how many times they were unemployed and how long they spent out of work. We could also see what sort of job they had and whether or not they gained promotion – this enabled us to identify if they suffered from job instability or other types of cumulative disadvantage.

Wear and tear

Participants in the study were also asked to fill in health questionnaires as well as undertaking medical examinations and giving blood samples. This enabled us to calculate their ‘allostatic load’ (AL) – a biological measure of the wear and tear on the body (i.e. the damage to the body) which accumulates as an individual is exposed to chronic stress throughout working life. And that is associated with long-term conditions such as heart disease, type-2 diabetes and depression.

In this study we were able to include measures on a total of 10 items to measure allostatic load, including blood pressure, lung function, waist-to-hip ratio, cholesterol levels, kidney function, fasting blood sugar and the immune and inflammatory system.

Men and women were considered separately and we were able to look at whether participants were in a stable relationship as well as their level of education.

Our key findings were as follows:

– Both men and women who suffered disadvantage at work had a higher allostatic load: it was possible to measure physical health effects linked to work stress. Women who had skilled or semi-skilled jobs had a higher load than managers or professionals. Both men and women suffered if they had been out of the labour market for six years or more.

  Men who were rejected for promotion had slightly higher scores, as did women who had a high number of temporary jobs.

  • Frequent job moves were not associated with ill-effects on health: these might be made for positive reasons such as promotion.
  • The effects remained even after we controlled for other career characteristics. They were the same for all the different health indicators we looked at, bar one: kidney function.
  • The impact on health was particularly high for those who had continuously been in low-skilled, high-stress types of work, with repeated or lengthy periods of unemployment.

Adversity

Our study suggests that people who suffer adversity in their working lives over an extended period are more likely to suffer long-term health conditions in later life. It underlines the importance of those links between chronic work stress and disease. 

The potential benefits of promoting healthy work conditions, particularly among more disadvantaged groups and at early stages of their working lives, are clear from this study. The potential benefits will support both employees, in helping them to stay healthy for longer, and employers, who could cut rates of sickness and retirement through ill-health.

Adverse employment histories and allostatic load: associations over the working life is by Morten Wahrendorf , Tarani Chandola , Marcel Goldberg, Marie Zins, Hanno Hoven and Johannes Siegrist, and is published in the Journal of Epidemiology and Community Health.

Being accommodating in the workplace: could it help close the disability employment gap? 

In 2020, 8.4 million people of working age (16-64) reported that they were disabled which is 20% of the working age population. 52 percent of disabled people aged 16-64 were in work compared with  81 percent of non-disabled people. It’s a gap the Department for Work and Pensions wants to tackle, but good research for evidence-based policy solutions in this area is thin on the ground. New research from Tarani Chandola and Patrick Rouxel suggests that ‘workplace accommodations’ such as flexible or part-time working, mentorship and training and support could help the Government achieve its 10 year ambition to halve the disability employment gap.

In its 2017 policy paper Improving lives: the future of work, health and disability, the DWP committed to seeing the number of  disabled work in work rise by 1 million from 3.5 to 4.5 million over the subsequent 10 years. 

When we talk about the disability employment gap we mean the difference between the number of people with a disability who are in work compared with those without a disability. The gap comes about through people having to leave work through ill-health or the onset of physical or mental health problems whilst working, together with the fact that if you’re disabled, you have considerably lower chances of getting a job in the first place. The large majority (83 percent) become disabled whilst they are in work and once they do the likelihood of them being in work a year later is much reduced.

There has been little research in this area, particularly when it comes to looking at all this in the round in order to get the bigger picture as it relates to all workers who use some sort of work place accommodation or adjustment to how, where and when they carry out the role. In order to make sound policy recommendations that work for disabled people and employers, the Government has been looking to develop a more comprehensive evidence base. 

Rather than starting with a person’s medical condition, we thought it could be useful to examine which workers (no matter the state of their health) are able to access e.g. a technical solution that means they can fulfil a role they otherwise wouldn’t be able to, as well as a range of flexible arrangements such as working hours, modified duties, being based at home, having access to a mentor. 

We wanted to try to establish who and how these arrangements and adaptations help to remain in work.

Barriers faced

We made use of information on more than 6,000 participants from the Life Opportunities Survey , which looks specifically at the barriers disabled people face in participating in various aspects of life including work. 

Around a third of the people we looked at who were in work reported some sort of impairment – a problem with their sight, hearing, mobility, pain, breathing, learning mental health or with a range of other conditions and disability-related issues. They were more likely to be out of work a year later than peers with no impairment, particularly if their impairments were to do with mobility or dexterity in which case they were three times more likely to be unemployed.

Workers with some sort of impairment or disability who had modified work duties or hours were more likely to remain economically active (in work or looking for work) than those who reported no such accommodations.

Modifications

A modified work area or equipment led to workers being twice as likely to stay in work. Indeed the more modifications reported, the more likely workers with an impairment were to be in work one year later.

Particularly noteworthy was how true this was for workers with mental impairments. Those who had no workplace accommodations were over 2/3rds (or 70 percent) less likely to remain in work than workers with no mental impairment.

This stark gap closed where two or more accommodations were reported. Also interesting was the fact that people with mental impairments were considerably less likely than those who reported physical pain to report an increase in their workplace accommodations. 

Looking at the wider picture of who accesses work accommodations and why, the main reason was not actually related to disability at all, but with having caring responsibilities.

The key things we learn from all this are that despite the evidence that workers with mental impairments could benefit considerably from workplace accommodations, they are less likely to have their workplace adjusted to take account of it.

This is something that could be a focus for policymakers and employers looking to close the disability employment gap. It should be especially helpful in informing managers and supervisors who have a crucial role in creating healthy and inclusive workplaces where all can thrive and progress. 

The role of workplace accommodations in explaining the disability employment gap in the UK is research by Tarani Chandola and Patrick Rouxel and is published in Social Science & Medicine.

Youth unemployment and later mental ill-health: who is at risk?

The pandemic has brought links between unemployment and mental health to the fore. With joblessness having risen across the globe, new research looking at the longer-term effects is particularly timely. Liam Wright and colleagues from UCL’s Department of Epidemiology and Public health describe new research which could motivate efforts to target vulnerable groups and use resources efficiently.

We have known for some time that unemployment has a detrimental effect on mental health. And we know, too, that these effects can last for many years. A large body of research tells us those who have a spell out of work when young are more likely to suffer from poor wellbeing, depression and anxiety even decades later. 

It’s particularly useful to study these effects through the lens of youth unemployment, for two main reasons. First, unemployment rates are higher for those under 25 and recessions have a disproportionate effect on them. Second, unemployment at this formative stage of life may have a greater impact than unemployment later on: it can affect the way young people see themselves and can set off ‘chains of risk.’

Negative experiences during youth can have a measurable impact on our responses to stress, and that this can have a lifelong effect on our physical and mental health.

But until now we don’t know much about the reasons behind these links, or about whether these impacts were experienced differently by different groups of people. By learning more about these things, we should be able to direct resources more effectively to those who are likely to need extra help.

We decided to look at whether unemployment had a stronger association with later mental health for some individuals than others using a statistical technique called quantile regression. We also looked at whether the association was stronger for those with longer unemployment spells, was larger in men or women, and whether later employment success (which is thought to explain the association) was associated with relatively better mental health.

Mental health

We used data from Next Steps, formerly the Longitudinal Study of Young People in England, which followed a cohort of English school children who were aged 13 and 14 in 2003-4. The group were followed up to the age of 25– by that stage, there were 7,700 in our sample.

The mental health of the participants was measured at age 25 using the General Health Questionnaire or GHQ-12, a screening tool which can pick up mood and anxiety disorders and which scores them on a 36-point scale of seriousness – with 36 the most serious. We also took account of whether the respondents had a disability, their mental health during adolescence, as well as how they saw their general physical health.

We were able to compare these health scores with the employment status of the young people, focusing on those who had been unemployed for six months or more around the ages of 18 to 20 – this took place between 2008-10 and coincided with the global financial crisis, after which youth unemployment rose significantly.

We took account of a range of other factors such as gender, ethnicity, neighbourhood deprivation, educational attainment at age 25 and risk-taking behaviours such as drug-taking, alcohol, smoking and anti-social behaviour.

The results supported our key hypothesis that the association between youth unemployment and later mental health was driven by a relatively small proportion of formerly unemployed individuals who had very poor levels of mental health. Our model suggested that among a set of hypothetical individuals with average characteristics, more than 30 per cent of those who had been unemployed more than six months would have GHQ scores over 15 on the 36-point GHQ scale; 10 percentage points more than those who had not.

These effects could be seen even among those who were employed by age 25, and there was some evidence that the association was greater for men than for women.

Who’s at risk?

Our findings support and extend our existing knowledge, and they also pose questions: who are the individuals most at risk? We know men are more vulnerable in this respect than women, though this may be in part due to the greater likelihood that they are seeking work as opposed to looking after children, for example. But do men suffer more in economic, as opposed to mental health, terms?

We might also look at whether certain personality traits can help or hinder the wellbeing of those who find themselves unemployed while young. For example, does it help to feel that one has control over one’s own destiny, rather than taking a more fatalistic approach?

And we might look, too, at the mechanisms through which scarring takes place. Could unemployment while young affect people’s neuro-behavioural development? Or should we focus more on the ways in which an early spell of unemployment can cause problems later in the jobs market?

The answers to these questions could help us to identify vulnerable groups more accurately, and to point towards policy solutions which could potentially reduce these scarring effects in the future.

Heterogeneity in the Association Between Youth Unemployment and Mental Health Later in Life: A Quantile Regression Analysis of Longitudinal Data from English Schoolchildren, is research by  Liam Wright, Jenny Head and Stephen Jivraj of the Department of Epidemiology and Public Health, University College London, and is published in BMJ Open (http://dx.doi.org/10.1136/bmjopen-2020-047997).

Could having a psychologically demanding job actually be good for you?

Recent research has highlighted that those in psychologically demanding jobs which don’t offer possibility of control are more likely to become ill or to leave the labour market early. But a new study carried out in Sweden suggests the picture may be more complex than previously thought – for some workers, having a demanding job can be associated with good outcomes. Kristin Farrants from the Karolinska Institutet outlines what she and colleagues found and what it might mean for extending people’s working lives.

Governments across the developed world are interested in exploring how people can be enabled to extend their working lives. And a key part of that discussion has focused on how working conditions affect the likelihood that workers will stay on longer.

We know from earlier research that the working environment can affect how people feel about working into later life – if they are in jobs which are demanding but which don’t give them much control, they tend to want to leave. But until now we didn’t know much about what actually happened – do those intentions turn into reality? And what is the relationship between the demands of the job and the amount of control the worker has, when it comes to working after the usual retirement age?

We used nationwide register data from Statistics Sweden, to study all the 55-64 year-olds living and working in Sweden in December 2001. We followed up the same individuals 11 years later, in 2012, to see whether they were still working.

As predicted, we found that those who were in jobs with low levels of control in 2001 were less likely to be in paid work in 2012, while the reverse was true for those with a high level of control over their work tasks.

But when it came to how demanding the job was, the picture was more nuanced. Overall, those with more demanding jobs were less likely to have old-age pension, sick-leave benefits, or social assistance, 11 years on, than those with less demanding jobs, while those with low-demand, low-control jobs were less likely than others to carry on working.

Women and men

But there were significant differences between women and men. We found that when it came to control at work, women who had a high level of control over their work tasks were more likely to stay on in paid work, even if their jobs were not very demanding. For men, this was only the case if their jobs were both high-demand and high-control.

A possible explanation for these gender differences is that the jobs market in Sweden is highly gendered: perhaps the difference is in the type of jobs men and women do, rather than in the level of control or stress they have. It could also be due to differences in other factors, such as family needs, income or health.

Our findings support the underlying theory, which was first proposed in the 1970s by Robert Karasek. His Job Demand Control Model suggests it is high demands in combination with low control that leads to stress which can be bad for our health. Karasek’s model suggests that it is not stress, per se, which makes us ill – it is the mismatch between being asked to do a lot and yet not feeling in control of how we do it. So if our jobs are very demanding yet we feel we are in the driving seat, that makes a big difference to us.

Staying in paid work

Why does this matter? Across the developed world we have falling birth rates and increasing life expectancy – so it’s important to governments that people stay in jobs rather than retiring early. And if workers can stay healthy, this will be easier to achieve.

We already know that low levels of control are associated with high levels of disease, disability and sick leave. But the evidence about the role of job demands has been more equivocal.

Our research adds new depth to the picture. High-stress jobs are not necessarily bad; in fact a demanding job can be a positive factor in older people’s lives. Jobs which stretch and challenge us can keep us moving on in the labour market – and as well help us stay healthy.

Associations between combinations of job demands and job control among 616,818 people aged 55-64 in paid work with their labour market status 11 years later: a prospective cohort study, by Kristin Farrants, Jenny Head, Elisabeth Framke, Reiner Rugulies and Kristina Alexanderson, is published in International Archives of Occupational and Environmental Health .

Lockdown – just how stressful has it been?

2020 is a year many will be happy to see the back of. It has been a stressful time for sure with periods of lockdown creating major challenges for our day to day work and family lives. But have the stresses and strains associated with lockdown affected the mental health of the UK population as a whole? Tarani Chandola and colleagues have been using specially collected COVID19 data to investigate.

On March 23, the UK found itself in its first lockdown, a direct result of rising infection rates and deaths caused by the pandemic. The new normal for many was working from home whilst trying to homeschool children. The weekly shop involved queues and masks and social distancing. Getting a doctor or dentist appointment or scheduled medical treatment took on a whole new dimension. Trips to the pub, cinema and theatre were things people could no longer look forward to and looking out for elderly relatives and friends became more important and challenging in equal measure.

Gradually through the Summer months, many of these restrictions were eased and the majority of children returned to school. Businesses including pubs, gyms and hairdressers were able to re-open albeit with strict social distancing and hygiene measures in place.

The severity of the restrictions combined with the direct effects of the disease itself created what might be described as a perfect storm of increased potential stresses likely to adversely affect the mental health of people everywhere. Most of us will have felt fearful about catching the disease, and many will have experienced additional worries for already vulnerable family and friends. The realities of working at home brought its own challenges while for others being furloughed or losing their job brought additional anxiety. 

Although there have been widespread reports of worsening mental health and wellbeing through the first UK lockdown, there have also been some reports that this eased somewhat through April and May although not back to pre-pandemic levels.

COVID-19 data

In our research, which made use of data from Understanding Society including its specially-collected COVID-19 study, we were able to look across a slightly longer period of time at the experiences of between 13,000 and 17,000 people in the UK. These were people who had been involved in the survey for many years, so there was a great deal of background information available as a backdrop for our research. 

We wanted to see whether more people were reporting struggling with mental health problems and to what extent the prevalence of problems was directly related to the stresses and strains of lockdown and the pandemic specifically. We also wanted to see if, after the initial ‘shock’ of events in April eased in subsequent months as people began to adapt and ‘get used to’ their new circumstances.

Between April and July study participants were asked a range of questions directly related to the disease itself including whether they had had it, been tested for it or experienced symptoms. There were also questions about any other health treatment, their families, work and money- related concerns such as struggling to pay the bills.

Every month people were asked about their work status so we could see for example  who was employed, self-employed, working reduced hours, furloughed or been made redundant. They were also asked about hours spent on childcare and homeschooling or whether they felt lonely.

Common mental disorder

Before lockdown just under 25 per cent of people in the UK had experienced mental health issues and this rose to just over 37 per cent in April, so more than a third of the population. There was a gradual dropping off of cases through to July (just under 26 per cent) taking things almost back to pre-lockdown levels. 

The percentage of new cases of mental health problems among participants in April was double (around 28 percent) what it was in the preceding 12 months.

And recovery rates from a mental health issue dropped from pre-lockdown months through April to June but picked up again in July, by which time social restrictions had been eased considerably and, our research shows, potential stressors around COVID itself, juggling work and family responsibilities and health, business and money concerns had decreased for most.

The number of people who reported having some sort of health limiting condition and having to cancel or postpone medical treatment halved from April to July. Over the same period, the number of self-employed people who said their business had been adversely affected also went down from 3.6 percent to 0.6 percent. Employees who reported being made unemployed or being on reduced hours also more than halved and there was only a small increase in the proportion of people describing themselves as ‘economically inactive’. 

Rates of reporting ‘often feeling lonely’ went down from 8.8 to 6.7 percent and fewer people reported having to spend more than 16 hours a week on childcare or homeschooling although there was a small increase in the proportion of people spending 1-15 hours on those tasks.

For some people, problems with paying bills remained an issue throughout the period,  although the percentage of people who said they found things very difficult financially or who said the future looked bleaker financially reduced somewhat from April onwards. 

Which stresses affected people most?

The strongest link between lockdown related stress was loneliness. People in the survey who reported ‘often feeling lonely’ were 11 to 16 times more likely to have mental health problems from the April to July compared to those who never felt lonely. Other important stressors were having COVID-19 symptoms and always working from home. 

Self-employed people whose businesses were negatively impacted by COVID-19 were more likely to develop a mental health problem compared to their peers whose businesses were not. And by July, employees who became unemployed, or were made redundant or whose work hours were reduced were over two times as likely to develop a problem compared with those who were unaffected. 

Adults doing16 hours or more a week on childcare or home schooling were about 1.4 times more likely to develop a problem compared to those who had no children or did not spend any time on childcare. 

Adults who were finding it quite or very difficult financially were 2.4 times more likely to develop a mental health issue compared to those who were living comfortably. Similarly, adults who expected their future finances to be worse off than now were 1.6 times more likely.

Longitudinal analysis

Our findings from looking at this group of people across April to July are in line with other surveys undertaken by the Office of National Statistics and the UCL COVID-19 study of 90,000 adults. We add to that picture by looking more closely at which stressful circumstances are most likely to drive up incidences of poor mental health during a pandemic of this nature. 

We conclude that despite the lifting of many lockdown conditions by July and a decrease in the levels of many of the psychological and social stressors, these stressors continued to drive poor mental health among people who were lonely and those who were made unemployed or redundant, had financial problems or had childcare or home schooling duties.

As unemployment and redundancy increase in the labour market, an inevitable result of recent events, it will be important to keep monitoring the mental health consequences of unemployment. It is Interesting also to note that employees who were furloughed had about the same levels of mental health problems as employees whose job hours were not affected. This suggests that the government measures to protect jobs also had positive mental health benefits for those employees who were able to keep their jobs albeit in a “furloughed” state.

The mental health impact of COVID-19 and lockdown-related stressors among adults in the UK is research by Tarani Chandola, Cara Booker, Meena Kumari and Michaela Benzeval and  is published in Psychological Medicine

Leaving school: how do work and family transitions affect women’s wealth and wellbeing later on?

How have the early adult lives of a generation of young women who grew up after the war impacted on their lives now? Baowen Xue and Anne McMunn from the ESRC International Centre for Lifecourse Studies at UCL discuss two new papers which look at life satisfaction, mental health and economic wealth among older women. Their findings suggest early marriage and domestic labour are linked to worse outcomes later in life. 

The move out of education into work, marriage and parenthood is a sensitive time for young people and can set the course for their later lives. So which circumstances have turned out to be beneficial, and which have been less so?

We used data from the English Longitudinal Study of Ageing, ELSA, to look for answers to these questions. Our study followed a sample of over-50s who have been interviewed every two years since 2002. A Life history interview was conducted additionally to collect information about their  education, work and family lives.

We identified a group of almost 4,000 women born before 1956 who answered questions on life satisfaction and mental health, and in our second paper a smaller group of just under 1800 for whom income data was also available.

Our hypothesis as we set out on the research was that those who married and had children later, and who therefore tended to have stronger ties to work early on, would have better mental health in later life. This largely proved to be true, though remaining single was not the answer: this group tended to suffer from isolation and loneliness later in life.

We identified six types of transition from education into work and family life: Early marriage and domestic labour, later marriage and domestic labour, later marriage and later work entry, later marriage and early work entry, early work entry and remaining single, and a group whose experiences were mixed and included lone parenthood, marriage with or without children and a mixture of employment types.

Early motherhood and domestic labour

The key finding in our study was that women who took on motherhood and domestic labour at an early stage were more likely to suffer from depression and lower life satisfaction in later life than those who went to work early and married late. Those with mixed histories and those who stayed single and childless were also more vulnerable to poor mental health and low life satisfaction. But those who started work late – often through staying in education – and also married late had the highest life satisfaction and the lowest level of mental illness.

We found that these effects could by and large be linked to socioeconomic status: those from more privileged backgrounds tended to gain higher educational qualifications, to enter work later and to marry later, and that set them on a path to a better quality of life later on. Conversely, those from less privileged backgrounds tended to gain fewer qualifications, to marry earlier and to have a poorer quality of life later.

A second paper, also using ELSA data asked a linked question: how does leaving full-time education and becoming a home-maker at an early stage affect women’s economic wealth later in life?

We took the life histories of just under 1800 women born between 1939 and 1952, and looked at when they left education as well as how their entry into work affected their financial situation in later life. 

We found those who left education early and went straight into domestic roles were four times less likely than their more educated peers to be in the highest household wealth bracket in later life.

Women who started work between the ages of 21 and 24 were 40 per cent more likely to be in professional or managerial jobs than those who left school by age 16 and started work early. They were 53 per cent more likely to be in the top earnings bracket for women of their age and were almost four times more likely to be in the top bracket for total household wealth.

We concluded that the age at which women leave education plays a pivotal role in their later economic, personal and mental wellbeing. For the generation of women who are now pensioners, an early entry into domestic rather than paid labour cast a long shadow, while higher education conferred particular advantages. 

As higher education and later partnership have become the norm for today’s young women, these studies will form a baseline which will one day enable us to see whether their experiences compare or contrast with those of their grandmothers’ generation.

The Long Shadow of Youth: Girls’ Transition From Full-Time Education and Later-Life Subjective Well-Being in the English Longitudinal Study of Ageing is research by Baowen Xue, Penny Tinkler and Anne McMunn and is published in the Journals of Gerontology: Social Sciences

Girls’ transition to adulthood and their later life socio-economic attainment: Findings from the English Longitudinal Study of Ageing is research by BaoWen Xue, Penny Tinkler, Paola Zaninotto and Anne Mc Munn and is published in Advances in Life Course Research.

Anne McMunn and BaoWen Xue are based at the ESRC International Centre for Lifecourse Studies in Society and Health at UCL. Paola Zaninotto works with the English Longitudinal Study of Ageing at UCL and Penny Tinkler is based at the Manchester Institute for Collaborative Research on Ageing.